The Medical Student & Medical Trainee CHANGE Studies

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Do interactions with LGBT individuals in medical school predict less sexual orientation bias?

In a study presented at the 2019 Society for Personality and Social Psychology convention, Natalie M. Wittlin and colleagues examined the relationship between early-career physicians’ interpersonal experiences during medical school and their biases against lesbian and gay individuals two years later, during residency.

Key findings:

The more they had interacted with LGBT individuals during medical school, the less bias against lesbian and gay individuals they reported during residency.

The more positive their interactions with LGBT individuals during medical school had been, the less bias against lesbian and gay individuals they reported during residency.

Those who had heard physicians make negative comments about sexual minority patients during medical school reported higher levels of bias against lesbian and gay individuals during residency.

Interacting with LGBT individuals during medical school may produce lasting reductions in bias against lesbian and gay individuals. Witnessing role models make disparaging remarks about LGBT individuals, however, may produce sustained increases in bias.

Do rates of burnout and career choice regret among resident physicians vary by clinical specialty?

In a paper in JAMA: The Journal of of the American Medical Association, Dr Lisolette Dyrbye and colleagues explored factors associated with symptoms of burnout and career choice regret during residency.

Key findings:

Burnout was prevalent in the sample (45.2%) but varied substantially by clinical specialty, with residents in urology, neurology, emergency medicine, ophthalmology and general surgery reporting more burnout. Female residents had a 7.6% higher risk of burnout than male residents.

Most resident physicians were satisfied with their career and specialty choice. However, career choice regret was reported by 14.1% of the sampled residents, and was highest among residents in pathology, radiology, and anesthesiology.

Residents with higher anxiety and lower empathy during medical school were at greater risk of subsequent burnout and specialty choice regret during residency.

The authors recommend further research to better understand differences in burnout and career choice regret among US resident physicians.

Informal training experiences may contribute to changes in racial bias among medical students

In a study published in Social Psychology Quarterly, Dr. Sara Burke and colleagues examined the effects of both formal and informal experiences on non-African American medical students’ attitudes toward African Americans.

Key findings:

Interracial contact was an important predictor of positive attitudes toward African Americans.

Students who witnessed instructors make negative racial comments or jokes were significantly more willing to express racial bias themselves.

According to the authors “explicit antiblack attitudes remain an active and pressing concern in medical training and demonstrate the urgency of addressing racial bias in the informal culture of medicine.”

Medical school factors associated with changes in implicit and explicit bias against gay and lesbian people

In a study published in the Journal of General Internal Medicine, Dr. Sean Phelan and colleagues examined how medical school curriculum, role modeling, diversity climate, and contact with sexual minorities predict bias against gay and lesbian people.

Key findings:

In medical schools where faculty discrimination against LGBT patients was more common, students experienced an increase in bias toward gay and lesbian people over the course of medical school.

Students who felt more prepared to care for LGBT patients had lower bias toward gay and lesbian people.

Both the amount of contact with sexual minorities and the perceived quality of that contact were associated with reduced bias during medical school.

Medical student biases toward sexual minorities may improve during medical school with training in providing care to sexual minorities, improved diversity climate, less negative role modeling, and more favorable interaction with sexual minorities.

Does a negative medical school diversity climate impact the depression scores of medical students?

In a paper published in the Journal of the National Medical Association, Dr. Rachel Hardeman and colleagues examined whether students’ perceptions of their medical school diversity climate was associated with an increase depression symptoms over the course of medical school.

Key findings:

Nearly two-thirds of students reported exposure to a negative racial climate at their medical school, particularity witnessing racial insensitivity from other students or faculty. Most students also reported witnessing discrimination towards other students (81%) and negative role modeling (94%).

Negative racial climate, witnessed discrimination, and negative role modeling were independently and significantly associated with an increase in depression symptoms during medical school, even after controlling for students’ personal experiences of mistreatment.

A negative diversity climate is harmful to all students regardless of race, and is particularly detrimental to Asian students.

According to the authors, “creating an institutional environment that is fair, equitable and inclusive is vital to maintaining the health and well-being of all medical students. In order to do so, medical schools must seek to systematically document and understand the aspects of their institutional climate that contribute to both equity and inequity.”

Study background and purpose

Medical Student CHANGE & Medical Trainee CHANGE Studies were funded by two R01 grants from the National Heart, Lung and Blood Institute, National Institutes of Health*. The study was originally conceived by Michelle van Ryn, PhD (Principal Investigator) and John (Jack) Dovidio, PhD (Yale Site Investigator) in order to determine whether medical training factors had an impact on physician biases and/or equity of care.

While there is clear evidence of disparities in health care and compelling evidence that provider bias contributes to a portion of these disparities, there is a dearth of research evidence regarding the individual and medical school/residency factors that increase or decrease the likelihood of new provider implicit and explicit bias. This study is designed to fill this gap in knowledge and to inform the development of effective interventions to reduce bias among emerging physicians.

The primary purpose of the studies is to examine the impact of medical school and residency organizational climate, role model behavior, and formal and informal training experiences on new physician biases and characteristics (well-being, attitudes, and practices) associated with disparities in care.

The secondary purpose of the studies is to examine the impact of medical school and residency characteristics on outcomes among new physicians who are members of marginalized social groups (under-represented minority, sexual minority, and have obesity).

Are data available for download?

Currently data are not available for download. However, we invite those interested in working with CHANGES data to contact us about becoming a guest investigator.

How can I become a guest investigator?

If you’re interested in becoming a guest investigator, we welcome you! We have established a set of guest investigator policies to ensure that all study products have the highest scientific integrity and to maintain inclusive and collegial collaborations.

Guest policies include:

Close collaboration with a core CHANGES investigator (i.e., “sponsorship”).

Submission of a signed data use agreement.

Submission of current human subjects research training documentation.

Submission of a Paper Proposal Form.

Participation in at least two CHANGES team video-conferences.

Commitment to following study rules and procedures for scientific integrity, data security, and collegiality.